The Coronary Calcium Scan: Why Everyone After 30 Should Try It
An important preventive measure for heart disease and stroke based on my years of research
I also published this story for my readers on Medium.
As a technologist and scientist, I am fascinated by the tools that allow us to peer inside our bodies and reveal their hidden workings. One such tool, the CT coronary artery score test (commonly known as a coronary calcium scan), provides a unique and vital window into the health of our hearts.
This non-invasive and valuable scan uses advanced X-ray technology to measure the amount of calcium buildup (calcified plaque) in the arteries that supply blood to the heart. This buildup is a critical indicator of atherosclerosis, the primary cause of most heart attacks and strokes.
Heart disease remains the leading cause of death worldwide, usually striking without warning. The coronary calcium scan can detect early signs of trouble, even before symptoms appear, allowing for early intervention prevention as a potentially life-saving preventive measure.
Many studies that I reviewed have shown that people with a high calcium score are at a significantly increased risk for cardiac events. I provided links to some seminal papers at the end of this article.
How Does a Coronary Calcium Scan Work?
The coronary calcium scan, also known as a heart scan, is a non-invasive imaging test that uses computed tomography (CT) technology to detect and quantify calcium deposits in the coronary arteries. Here’s how it works:
Preparation: The test requires minimal preparation. You may be asked to avoid caffeine or certain medications before the scan, but there’s no need to fast or change your daily routine.
Procedure: You’ll lie on a table that slides into the CT scanner, a doughnut-shaped machine. The scan takes only a few minutes and is painless. In some cases, you may receive a contrast dye intravenously to enhance the images, but this isn’t always necessary.
Image Acquisition: The CT scanner takes X-ray images of your heart from different angles. These images are combined to create a detailed 3D picture of your coronary arteries.
Calcium Scoring: Specialized software analyzes the images to identify and quantify calcium deposits in the artery walls. These deposits are a sign of atherosclerosis, a buildup of plaque that can narrow the arteries and increase the risk of heart attack or stroke.
Results: The results are reported as a calcium score, a numerical value reflecting the amount and density of calcium in your arteries. A score of zero indicates no detectable calcium, while higher scores indicate more extensive calcification and a higher risk of heart disease.
The calcium score does not solely predict an immediate heart attack or stroke but helps assess your overall risk of developing them in the future. Your cardiologist can use the calcium score and other risk factors like age, cholesterol levels, other lipids, blood pressure, inflammation markers, insulin resistance, and family history to determine the best action for your heart health.
Who Should Consider It?
While guidelines vary, the coronary calcium scan is generally recommended for people aged 40 to 70 with intermediate risk factors for heart disease.
In my opinion and intuition, based on years of research, starting at age 30 is more prudent because plaque begins forming around this time, and the earlier we detect it, the better measures we can take to prevent heart disease.
I mention this because I know people who have died at very young ages due to silent heart disease. I even wrote a personal story about this last year.
When Dave Died from a Heart Attack at a Young Age, I Was Deeply Sad But Not Surprised
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The scan is particularly recommended for people with a family history of heart disease, high cholesterol, hypertension, diabetes, or a history of smoking.
The ACC/AHA guidelines recommend selective use of CAC scoring in people with intermediate risk (5–20% 10-year risk) of atherosclerotic cardiovascular disease, where the decision to initiate statin therapy is uncertain.
Here’s a link to a relevant ACC resource that discusses using CAC scoring in primary prevention: The Ever-Growing Role of Coronary Artery Calcium in Primary Prevention. This article comprehensively overviews CAC scoring and its evolving role in cardiovascular risk assessment and prevention strategies.
What are the main benefits?
Identifies heart disease risk before symptoms arise. It helps determine individual risk levels and guides treatment decisions. A high score can be a powerful motivator for making healthy lifestyle changes, while a low score can provide reassurance and peace of mind.
What do the scores mean?
0: No detectable calcium. Low risk of heart attack. 1–99: Small amount of calcium. Mild atherosclerosis. 100–399: Moderate amount of calcium. Moderate atherosclerosis. 400 and above: A large amount of calcium. High risk of severe atherosclerosis and heart disease. A high score does not necessarily mean a heart attack is imminent, but it does signal the need for lifestyle changes or medical interventions to reduce your risk.
Are there any limitations or side effects?
The scan involves a small amount of radiation. In rare cases, calcium deposits may result from causes other than atherosclerosis. Not all insurance plans may cover the test.
Is there any real science behind this test?
Yes, definitely. There are plenty! I reviewed multiple seminal papers by scientists, books by medical doctors, and practical references by clinicians like cardiologists and radiologists.
The science behind coronary calcium scans is well-established and robust. Numerous studies and clinical guidelines support its effectiveness in assessing heart disease risk. I summarize the findings of a few outstanding papers starting from the early 1990s with links.
Agatston et al. (1990) pioneered the use of ultrafast computed tomography (CT) to accurately measure coronary artery calcium in 584 individuals. They found that CT was more sensitive than fluoroscopy in detecting calcium deposits and that higher calcium scores correlated with an increased risk of coronary artery disease, especially in older age groups. This study established the Agatston score as the standard method for assessing coronary artery calcium and its role in predicting heart disease risk.
Greenland et al. (2007) published a comprehensive consensus document detailing evidence-based guidelines for using coronary artery calcium (CAC) scoring by computed tomography (CT) in assessing cardiovascular risk and evaluating patients with chest pain. The document emphasizes the utility of CAC scoring in risk stratification, particularly for asymptomatic individuals and those with low to intermediate risk, aiding in personalized prevention and treatment strategies.
Blaha et al. (2011) conducted a meta-analysis highlighting the significance of a zero coronary artery calcium (CAC) score as a strong predictor of low risk for future cardiovascular events. Their analysis emphasized the value of this finding in potentially conserving medical resources by identifying individuals who may not require further testing or aggressive interventions.
Nakamura et al. (2011) investigated gender differences in plaque characteristics in elderly patients with stable angina using virtual histology-intravascular ultrasound (VH-IVUS). While women initially appeared to have smaller vessel and plaque volumes, these differences became insignificant when adjusted for body surface area. Notably, women exhibited significantly higher dense calcium content in the culprit lesion compared to men, suggesting a potential gender-specific difference in plaque composition.
Budoff et al. (2015) demonstrated a strong association between coronary artery calcium (CAC) scores and long-term mortality risk in over 9,700 asymptomatic individuals, highlighting the predictive power of CAC scoring for cardiovascular risk assessment. This landmark study revealed that higher CAC scores significantly correlated with increased all-cause mortality over a 15-year follow-up period, even after adjusting for traditional risk factors.
Nykonenko et al. (2021) investigated the relationship between coronary artery calcification (CAC) severity, measured by the Agatston score, and the degree of coronary artery stenosis in patients with coronary heart disease. Their study found that a higher CAC score (≥400) was associated with more severe CHD and multivessel involvement. They also found that the degree of CAC was independent of anthropometric parameters like height, weight, and BMI.
Whelton and Blaha (2022) review the evolving role of coronary artery calcium (CAC) scoring, emphasizing its utility in predicting cardiovascular risk, guiding treatment decisions, and identifying high-risk individuals for clinical trials. They highlight the significance of CAC=0 in indicating low risk and discuss advancements in CAC assessment, including automated interpretation and its potential for further refinement.
Mohan et al. (2023) explain that coronary artery calcification (CAC) is a common occurrence as we age and is closely linked to atherosclerosis, the underlying cause of coronary artery disease. They emphasize that the presence and pattern of CAC can offer valuable insights into the presence and severity of CAD, with unstable angina often associated with smaller, scattered calcium deposits, while stable angina tends to have larger deposits.
For those who want to explore the intricacies of coronary calcium scans, atherosclerosis, and cardiovascular health, the following books offer a wealth of knowledge:
Prevention and Treatment of Atherosclerosis: Improving State-of-the-Art Management and Search for Novel Targets. Supported by the European Atherosclerosis Society (EAS), this open-access book provides a comprehensive overview of the latest advancements in atherosclerosis research, covering treatment optimization, new drug developments, and novel target discovery approaches.
Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine by Douglas L. Mann, Douglas P. Zipes, Peter Libby, Eugene Braunwald, Robert O. Bonow (2015). The definitive resource for cardiology, covering the latest in cardiovascular research, including coronary calcium scoring.
The Cleveland Clinic Guide to Heart Attacks by Dr Curtis Rimmerman (2006). Practical advice on heart disease prevention and management from a leading cardiologist.
The Bottom Line
The coronary calcium scan is beyond a simple tool. I see it as a glimpse into the future of our heart health. It is a proactive step towards a longer, healthier life — one you can take with or without a doctor’s referral.
This simple scan uncovers hidden risks and empowers us to make informed decisions about our well-being. Whether you seek peace of mind or a proactive approach to heart health, this scan provides invaluable insights.
Scientific evidence and clinical experience highlight the significance of this test in the fight against heart disease.
There are many more benefits to this test, which I will cover in another post.
You may also check out nine biomarkers for preventing cardiometabolic disorders.
9 Essential Biomarkers for Preventive Cardiometabolic Health
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I highlight insulin resistance as I see it as the most important causal and risk factor for cardiometabolic disorders. Please check out the stories in the attached list.
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Sounds like a painless procedure. Next time I get grief for high cholesterol even though my triglycerides are low and HDL is high, maybe I'll request the calcium test. I can't seem to convince my doctor that triglycerides of 85 and an HDL of 85 aren't normal--in a good way!